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issues in aging Flashcards

1
Q

young old vs old old

A

young 65-74 old old is 74+ oldest old is 85+

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2
Q

fastest groing protion of pop is

A

oldest old, 85+, growth rate is 2x those 65 and older, and 4x total pop

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3
Q

elderly poverty levels

A

15.9% live in poverty. 18% AA and hispanics

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4
Q

life expectancy for men and women

A

80.8 for W and 75.7 for men

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5
Q

reduced ability to mantain

A

increasesiwth age, average onset is 30 and manifested in organs by 50

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6
Q

key systems most vulnerable to illness or disease in the elderly

A

circulatory, musculoskeletal , lower Urinaly tract

CNS

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7
Q

predomininant presentations of illness and disease in the elderly

A 
delirium
dementia
falls
incontinence
functional decline
syncope
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8
Q

critical gero funcitons for NP

A

health promotion, health maintence, disease prevention facilitaiton of self care

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9
Q

Top 8 common conditions in older adults

A 
parkinsons
HTN
heart disease, 
respiratory disease
DM
Cancer
Cerebrovascular disease, 
atherosclerosis/alzheimers disease
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10
Q

top ten most common reasons for older adult hospitilazaions

A 
heart disease
CV disease
pneumonia
fractures
bronchitis
osteroarthritis
DM
nervouse system disease
prostate hyperpasia
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11
Q

most common causes of death in older adult

A 
heart disease 
cancer
cerebrovascular disease
COPD
pneumonia 
influenza
accidents
DM
septicemia
aterosclerosis 
HTN
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12
Q

social security

A

1200 a month, almost 15k per ear, for 36% of elders its 90% of income, for a quarter its the only income

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13
Q

danger signs that the elderly erson needs more help

A 
sudden weight loss
burns or injury marks
perculiar behavior of any kind
failure to take meds or over dosing
increased car accidents
generaized forgetfulness
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14
Q

if danger signs are present all housing options should be discusssed and analyzed

A

ageing in place etc

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15
Q

functional health assessment includes

A

eval of social and ecenomic resources
physical and mental health
cognitive status

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16
Q

advanced activities of daily living

A

complex measures of functional status, losing the ability in these activities may announce a major decline in overall health

include:
working
volunteering 
social activities
recreational activities
connection with peers and community
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17
Q

Instrumental activities of daily living

A

Shopping

Housekeeping-cooking, laundry, cleaning, and health maintence like going to the doctor

Accounting- managing financial matters

Food prep

Transportaiotn and telephone skills

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18
Q

generally lose what first

A

IADL before AADL

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19
Q

general ADL’s

A 
Dressing
Eating self feeding
Ambulating
Transferring and toileting 
Hygiene
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20
Q

functional assessment tools

A 
katz ADL scale
Barthel index
kenny self care scale
IADL
timed manual performance
performance test of ADL
framinham disability scale 
lawton scale
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21
Q

environmental assessment

A

must be conducted to adress the personal competence and physical limitations of the indiviual

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22
Q

some conditions that influence elderly safety

A

lighting
temperature- rec is 75 less than 70 can cause hypothermia
floor covering- rugs are bad,

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23
Q

bathroom thoughts for the elderly

A

lighting- keep it at all times
no thorw ruds
lever shaped faucet hanndles are better color code for temp

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24
Q

meds in environmental assesmet

A

label meds

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25
nutritional risk assesment protein
rec is 0.8g/kg/day albumin below 3.5% indicates protein malnutrition low protein can slow healing
26
calcium intake considerations
individualize absorption decreases with age is the patient lactose intolerant consider certain cancers nephrolithiasis hyperparathyroid
27
BMI ranges
underweight is less than 18.5% normal 18.5-24.9 overweight 25-29.9 obese over thirty
28
meds that can up appetitie
``` antidepressants tranqualizers beta adrenergic agents narcoleptics hormones steroids ```
29
nutirtional risk assessment | history
invountary weight loss change in appetite cange in clothing size ``` 5 pound loss in 1 month 5% of body weight in one month 7.5% in 3 months 10% in 6 months cange in funciton ```
30
albumin level normal
3.5-5g/dl
31
prealbumin
16-35mg/dl
32
transferrin
over 200mg/dl is normal
33
total lymphocyte counts
1,200 to 1,800 cells/mm3
34
primary reason for reduce sex in the oldies
dead dicks
35
troubling sexual stuff
forgot to do buttons failure to have same sex help from staff discusssing peeps and poos in front of peers
36
meds that can hurt libido
antihypertensives
37
conditions that can hurt libido
MI, mastectoym or prostectomy
38
atypical disease presentations caused by
``` changes in thermoregulation fluid volume regulaiton cardica immune alterations nervous system changes ```
39
age related thermoregulation changes
decreased heat production per kg of body weight reduce muscle activity decreased diet thermogenisis
40
normal oral rectal temps
35. 8 to 36.8oral | 36. 8 to 37.2 rectal
41
fluid volume regulation issues with older adults
deceased total body water decreased thrist drive decreased ADH response to dehydration
42
older adult renal function
impaired RASS responsivness | results in less water taken in less water on reserve, predisposing them to faster dehydration
43
sepsis in the older adults
40% of all deaths over 65 years old sepsis is 9times more deadly in older adults worse immune system and response, more co-morbidities, malnutrition. both protein and calory (30-60%
44
sepsis in the older adults
many 50% of adults with infection present WITHOUT fever
45
sepsis american medical directors association clinical practive guideline for fever in long term care
increase in tepm 1deg f or 1.1c from baseline two or more oral temp measurments of 37.2 or more or rectal over 37.5 or single temp measurment over 37.8 C
46
additional septic findings in the older adult
``` low oral inttake fatigue or withdrawal from activities agitaiotn confusion or delerium falls ```
47
Pharma considerations in gerontology -absorption
mostly unafected, focus on antacids (one hour before or four hours after other meds
48
pharmakokinetics
study of how the body interacts iwth druds including absorption, distribution, metabolism and excretion.
49
distribution
distribution, is unaffected unless the paitn is affected by serious CV disease
50
drugs that bind to plasma proteins
can be afffected by decrease in serum albumin levels
51
metabolism in the elderly with drugs
meatbolism may be significantly reduced in geriatric patients, particular if their is liver imparment- dose adustment may be necessary
52
liver and drugs in the elderly
decrease in hepatic blood flow can reduce the effectivness of the first pass phenomonon
53
elimination of drugs in the elderly
renal clearance is significantly reduced, theraputic doses can be lower than in the young,
54
pharmacodynamics
study of how drugs ineract with the body
55
receptor changes
receptors may up regulate, or down regulate with age, ccausign changes in sensitivity in to certain agent
56
homeostasis changes
decreased capacity to respond to physiological challanges and the adverse side effects of drug therapy eg orthostatic hypotension
57
pharmacogenitics
study of single gene genetic variations in drug variatioons
58
pharmacogenitics
how an individuals unique genitic makeup will aler the funcition of meds, benefits can include development of drugs taht max theraputic effects more accurate methods of determning doses prescribing fspecifically for nes genetic profile
59
pharmacogenitics vs genomics
genetics begins with an unusual drug response and the searches for a genitic cause genomics begins with lookign for genetic diffferences wh=thin a pop that explain certain observed response in a drug
60
adverse reactions in the elderly anticholinergic
blurred vision, urinary retention, constipation dry mouth
61
drugs most likely to cause adverse effects in the geriatric pop
``` benzos antipsychotics beta blockerssteroids ccimetidine narcotics diuretics ``` anticholonergic specific ones cholonergic agonists tricyclic anti depressants antipsychotics
62
drugs that effect balance and movement in the elderly
``` neuroleptics metronidazole phynytoin asa aminoglcosides lasix beta blockers vasodilarors metoclopromide ```
63
drugs with adverse effects on bone in the elderly
steroids, lithium heparin
64
promoting safe drug use
nearly 45% of the older pop is non adherent to prescribed meds polypharmacy is a problem- cdc says up to 12 meds daily also more OTC drugs then gen pop
65
promoting safe drug use self medication
may use meds that belong to someone else may have herbal meds provide ed of why a med is indicated AND why a med is not indicated
66
functional indicators like
mni mental or geriatrc depression screen may be good indicators about whether a pt can manage their meds
67
polypharmacy
``` prevention brown bag- bring in all the meds and see communication between pharmacy and doc is essential avoid combo products start with lowest dose ```
68
risks associated with polypharmacy
``` morbidity increased expense adverse reactions increase in depression risk of nursing home placement ```
69
OTC that complicate polypharmacy
cimetidine- inhibits p450 prolonging the effects of other durgs
70
otc and poly decongestants
are anticholinergics, the antagonize the activity or antihypertensives
71
otc and poly nsaids
decrease renal blood flow reduces elimination of many drugs
72
niacin and polypharmacy
may make antihypertensives stronger
73
antacids and polypharmacy
may absorb other oral agents, reducing transfer to gut wall
74
laxitives and poly
may chelated drugs reducing absorption | increase gut motility and can decrease absorption
75
calcium products and poly
may decrease absorbace of thyroid hormones tetracycline others
76
comorbidity influnces of meds renal
dose adjustments should be made on creatinine clearnece
77
hepatic disease and drugs
serum levels may be higher
78
cardiac disease and drugs
heart failure may effect perfusion and delivery leading to less than optimal theraputic outcomes

issues and policy (22 decks)

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